Dual-image videoangiography during intracranial microvascular surgery

Abstract Objective Indocyanine-green videoangiography (ICG-VA) is a precious tool to assess vessels and aneurysm patency during neurovascular surgical procedures. However, ICG-VA highlights vascular structures, which appear white over a black background. Therefore, anatomical relations are sometimes not easy to understand at first glance. The recently developed dual-image videoangiography (DIVA) enables the simultaneous visualization of both light and near-infrared (NIR) fluorescence images of ICG-VA. Methods The DIVA system was mounted on OPMI Pentero Flow 800 intraoperative microscope (Carl Zeiss Meditec, Jena, Germany). DIVA was used during microsurgical procedures on 5 patients, who were operated for aneurysm clipping and STA-MCA bypass. Results DIVA provides real time simultaneous visualization of both aneurysm and vessels and surrounding structures, as brain, nerves, and surgical clips. Although visual contrast between vessels and background is higher with the standard black-and-white imaging, DIVA makes it easier to understand anatomical relations between intracranial structures. Moreover, it gives a better vision of the depth of field. Conclusions DIVA has the potentials to become a widely used intraoperative tool to check the patency of intracranial vessels. It should be considered an adjunct to standard ICG-VA for a better understanding of vascular anatomy in relation to surrounding structures, and can have an impact in decision-making during surgery.